Clinical machine learning models experience significantly degraded performance in datasets not seen during training, e.g., new hospitals or populations. Recent developments in domain generalization offer a promising solution to this problem by creating models that learn invariances across environments. In this work, we benchmark the performance of eight domain generalization methods on multi-site clinical time series and medical imaging data. We introduce a framework to induce synthetic but realistic domain shifts and sampling bias to stress-test these methods over existing non-healthcare benchmarks. We find that current domain generalization methods do not achieve significant gains in out-of-distribution performance over empirical risk minimization on real-world medical imaging data, in line with prior work on general imaging datasets. However, a subset of realistic induced-shift scenarios in clinical time series data exhibit limited performance gains. We characterize these scenarios in detail, and recommend best practices for domain generalization in the clinical setting.

本研究基于多中心临床时间序列和医学影像数据，评估了8种领域泛化方法在现实世界医学成像数据上的性能，并对真实性产生的领域偏差和采样偏差而进行模拟压力测试，发现当前领域泛化方法在现实世界医学成像数据上的表现并不总是能够显著提升。然而，在临床时间序列数据的某些真实性突出情景下，这些领域泛化方法确实会呈现出一定的性能提升，建议在临床环境中采用最佳实践方法来进行领域泛化。

临床环境中领域泛化的经验框架